Genital cosmetic surgeons need greater awareness

25 July 2012

Practitioners of female genital
cosmetic surgery should be more aware of the wide variation in
appearance of female genitalia and be wary of performing surgery on women whose
genital dimensions are normal, says a new review co-authored by Dr Sarah Creighton from the UCL Elizabeth Garrett
Anderson Institute for Women’s Health.

The review is published today in The Obstetrician & Gynaecologist (TOG) and also points out that the long term risks of this
kind of surgery have not been sufficiently explored.

Labioplasty is the most common first-line FGCS procedure
and involves reduction of the labia and sometimes reduction of the clitoral
hood. Hymenoplasty involves creating scar tissue so that a woman whose
hymen is no longer intact can bleed the next time she has intercourse. Other
forms of FCGS, such as revirgination and G-spot amplification, are more
contentious and lack reliable data on their effectiveness say the authors.

The review explores the factors which may be linked to
this rise in FGCS procedures. Internet advertising has become a predominant
source of information for self-comparison among women and some television
programmes focussing on people’s body worries may direct women away from
self-acceptance, says the review.

In addition, women may request surgery because of rubbing
or pain during exercise. However, negative psychological preoccupations will
intensify unpleasant physical sensations and how troubled women feel about them.

Women should be made aware of the potential short and long-term risks and the absence of long-term data on clinical effectiveness.

Female body distress is complex and is more prevalent
than male body distress. However, it is not always fully understood and
healthcare professionals may be unaware of the wide variation of female
genitalia. The review recommends that doctors should be wary of conducting
cosmetic surgery on women whose genital
dimensions are normal. Furthermore, they should seek input from a psychological
practitioner trained in assessing and intervening in problems of body image,
sexuality and relationships.

Looking at the
long term risks, the review states that there are no well run prospective
studies on this with long term follow-up. Moreover, there is no information on
future obstetric performance.

The review also
looks at the links with female genital mutilation (FGM) and states that many FGCS
procedures compare anatomically with types of FGM.

Dr Sarah Creighton, UCL Elizabeth Garrett
Anderson Institute for Women’s Health says: “Gynaecologists
themselves must be familiar with the wide variation of genital appearance and
be able to reassure a woman of normality with confidence. Women should be made
aware of the potential short and long-term risks and the absence of long-term
data on clinical effectiveness.

“More guidance and
training is needed in this area in particular around psychological training.
More research is needed to look at why women and girls are increasingly
insecure about their bodies and gynaecologists have an important role in
promoting sexual wellness.”

TOG’s Editor–in-Chief, Jason Waugh said: “Female genital cosmetic surgery is on the rise
but there is little evidence on its long term effects. Women and gynaecologists
should be aware of the variation that exists in genital appearance and think
carefully about exploring the idea of surgery if it is not clinically
necessary.”